=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699361907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEIL'S REHAB AND FITNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2020
-----------------------------------------------------
Last Update Date | 12/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 SILVER OAK CT
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18974-3850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-397-6110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 SILVER OAK CT
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18974-3850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-397-6110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NEIL BAKHRU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-397-6110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------